P565 Pad

Consecutive number XXXXXX - XXXXXX To Accounting & Payments Service

√ appropriate box

Cumbernauld □ Shipley □

Consecutive number

0 0 0 0 0 1

Employer's details

Employer’s name (Use CAPITALS)

Employer’s reference Accounts Office reference

Details of overpayment

Year ending 5 April

| Tax | NIC | Total | |-----|-----|-------| | £ | £ | £ |

(Include ‘M’ to show a minus amount of tax or NIC)

√ one of these boxes in all cases. □ Wrongly allocated payment or □ Genuine Overpayment

Where it is genuine overpayment, RPI will be considered.

Disposal of the overpayment

☐ Reallocate to tax year

☐ Treat as permanent overpayment

Note: only overpayments of £10.00 or less should be put to permanent overpayments.

☐ Repay

Name of Payee (Complete in all cases using CAPITALS)

Address of where payable order is to be sent (Use CAPITALS)

Notional overpayment included in total repayment

☐ Reallocate to another √ as appropriate

☐ Special circumstances (please give details here)

Authorising officer’s signature Telephone number

Repayment Security officer’s signature (This must not be the Authorising officer)

Date stamp

P565 (part 1) To Accounting & Payments Service

√ appropriate box

Cumbernauld □ Shipley □

Consecutive number

0 0 0 0 0 1

Employer's details

Employer’s name (Use CAPITALS)

Employer’s reference

Accounts Office reference

Details of overpayment

Year ending 5 April

| Tax | NIC | Total | |-----|-----|-------| | £ | £ | £ |

(Include ‘M’ to show a minus amount of tax or NIC)

√ one of these boxes in all cases. □ Wrongly allocated payment or □ Genuine Overpayment

Where it is genuine overpayment, RPI will be considered.

Disposal of the overpayment

☐ Reallocate to tax year

OAS Number (AO Use only)

☐ Treat as permanent overpayment

Note: only overpayments of £10.00 or less should be put to permanent overpayments.

☐ Repay

Name of Payee (Complete in all cases using CAPITALS)

Address of where payable order is to be sent (Use CAPITALS)

Full name

Address

Postcode

Notional overpayment included in total repayment

☐ Reallocate to another √ as appropriate

☐ type of tax for example SA, CT, Reg 80 determinations

☐ employer

Year ending 5 April

| Tax | NIC | |-----|-----| | £ | £ |

Employer/taxpayer’s name if different from above

Accounts Office/Collection/Head of Duty reference

☐ Special circumstances (please give details here)

Authorising officer’s signature

Telephone number

Date stamp

Repayment Security officer’s signature (This must not be the Authorising officer) To Accounting & Payments Service

√ appropriate box

Cumbernauld □ Shipley □

Consecutive number

0 0 0 0 0 1

Employer's details

Employer’s name (Use CAPITALS)

Employer’s reference

Accounts Office reference

Details of overpayment

Year ending 5 April

| Tax | NIC | Total | |-----|-----|-------| | £ | £ | £ |

(Include ‘M’ to show a minus amount of tax or NIC)

√ one of these boxes in all cases. □ Wrongly allocated payment or □ Genuine Overpayment

Where it is genuine overpayment, RPI will be considered.

Disposal of the overpayment

□ Reallocate to tax year

OAS Number (AO Use only)

□ Treat as permanent overpayment

Note: only overpayments of £10.00 or less should be put to permanent overpayments.

□ Repay

Name of Payee (Complete in all cases using CAPITALS)

Address of where payable order is to be sent (Use CAPITALS)

Notional overpayment included in total repayment

□ Reallocate to another

√ as appropriate

□ type of tax

for example SA, CT, Reg 80 determinations

□ employer

Year ending 5 April

| Tax | NIC | |-----|-----| | £ | £ |

Employer/taxpayer’s name if different from above

Accounts Office/Collection/Head of Duty reference

□ Special circumstances (please give details here)

Authorising officer’s signature

Telephone number

Repayment Security officer’s signature (This must not be the Authorising officer)

Date stamp

P565 (part 3)(RSO copy)